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APPLICATION FOR ELECTR AL P I iJ
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUIELDING
BUILDING AND SAFETY DIVISION ADDRSS 7 ✓C.�'
JOHN A LAMBIE COUNTY ENO NEER
COLEMAN W JENKINS, SUPSRINTlNDCNT OF BUILDING FLOCALITY l '
NEAREST
F
OR APPLICANT TO 'ILL IN CROSS ST
NO
F
T_ s OWNERMAIL TOTAL FIRST 20 20 ADDRESS_ OVER 20 10 CITY TEL NO
PLAN CHECK
ING iTOTAL FIRST 20 20 APPLICANT
RES /( OVER 20 10 ADDRESS
—DRYER—WTR HTR _ CITY TEL NO
OOK_DISP _F A U _ CONTRAC rCI HTR _AIR COND _ ADDRESS Tim!ES WASH _OISHWASH CITY 00 TEL NOOTHER 1 00 LICENSE NO 1 U CLASS G7Z
TRANSFORMERS RATINGEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE 8 TYPE OVER TO AMO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING
0 — 1 00
I N[REBY CEPTIIY NAT AM P RLT R[0 jf REO AMD/OR
1 — 10 3 00 LICENSED AS REGUI D By OS A L l COUNT AND STATE OF
CALIFORNIA OR TMA I A HE L INNER OF AND INTEND TO
10 60 5 00 RESIDE IN THE ASO DES I RE310CH IAL PROPERTY
T 50 — 100 10 00 SIGNATURE
OF PERMITTE O
too - 500 Iso U
DIN GAS IST ICT P YO E P E D B
TU9E OR SIGN AND ONE CIRCUIT 9 00
w� iJ U
MA ROU EE ADDITIONAL CIRCUITS I OO NOTES 4 ! /' 4� N
SERVICE HOT OVER 600 VOLTS OR 200 AMP 2 00 J Z
SERVICE OVER 600 VOLTS OR 200 AMP 5 00
TEMP SERVICE POLE 6 APPURTENANCES 3 00 PCONDUIT
DATE INSP[CTD1s SIGNATURE
PERMIT FEE (SUBTOTAL)
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 200 UTILITY CO NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL
TOTAL FEE JOSEPH C ROOHAN
SUPERVISING ELEC AL ENGINEER
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M D CASH
1 1 8 3� J&29 2 D 4,Q9-
EE HACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ��